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Ebola virus, Education & Telemedicine: a SmartER Combination

The recent news about the Ebola epidemic are really catching the world’s attention, and I feel that it is important to keep updating this post about this most important, life-threatening topic.

I’m not an Infectologist. I’m not an Epidemiologist either. I’m just a Surgeon.

Like many healthcare professionals, I have been thinking about it for several weeks. In my particular case, I’m extremely alarmed and do worry that this current epidemic, will spread fast and take an enormous toll on its way to be eventually defeated.

FACTS: It is a virus, basically (RNA) protein that infects a host (in our case, humans) and replicates quickly, overwhelming the bodies capabilities to fight it. It attacks, among several targets, the lining of blood vessels (endothelium) and organs like the liver and immune response cells. It likes neutrophils (cells in charge of alerting the body that there’s an infection going on), blunting their ability to evoke a defense response.

Transmission occurs by the way of (ANY) body fluid from an infected person (but only after that individual is having symptoms). Symptoms appear between a few days to 3 weeks.

The virus is A SURVIVOR. It can be killed or inactivated while on the surfaces, with 3% Acetic acid solution (vinegar, alcohol based products, bleach (1:10-1:100 for >10 minutes), heat (heating at 60 degrees for 30-60 min, oiling for 5 minutes), UV radiation (moderately sensitive), bleach powder, etc.

Outside the host, it can survive for WEEKS in blood or contaminated surfaces, especially at low temperatures (4 degree Celsius)…winter is coming!. These facts are based on experimental findings and NOT BASED on observations in nature.

I think that the problem will be controlled only by the development of a VACCINE ( to provide immunity to people NOT INFECTED yet) and/or the development of a RAPID, mobile DIAGNOSTIC TOOL that allows detection of the virus, in a host, BEFORE the individual becomes SYMPTOMATIC and INFECTIOUS, hence CONTAGIOUS.

The current scenario: a lot of effort in screening symptomatic people in many places (affected areas, airports,etc), mainly to check whether they have symptoms (fever, pains, bleeding, etc). If they don’t have symptoms, THEY ARE RELEASED TO GO, and that’s it.

Imagine how many people might be infected with the virus, but when they were evaluated by the current protocol, they were found not to be symptomatic, so they got through the checkpoint.

I believe that the use of technology such as Telemedicine (m-Health), has a definite role in extending the reach of providers to patients thought to be at risk of becoming symptomatic.

Imagine, for instance, the possibilities of REMOTE AND MOBILE VTAL SIGNS MONITORING using wearable technology to keep those patients in “the radar”, without exposing anyone to them and risking becoming infected, while the period of “quarantine” lasts.

Having potential carriers of the virus wear sensors that automatically track an objective parameter such as temperature, heart and respiratory rates, so that abnormal elevations (i.e. fever) are immediately detected, and appropriate measures taken right away. Mobile thermal imaging has a very relevant, potential role in the fight to contain the spread of this illness.

The use of virtual reality presence (telemedicine) clinical interviews and follow-up of cases would make an ideal tool for extending the reach of providers without exposing them to infection.

Tele-mentoring of remotely located health personnel, guiding them with expertise and advice could prove an invaluable tool to optimize the treatment of patients and the development and deployment of strategies to fight this potentially lethal disease. Wearable computers (such as GoogleGlass) could potentially add to the armamentarium of healthcare workers.This particular device has the capability of being a “Touch-free” / voice activated-interface ( along with the current developments to integrate gesture commands, like the Myo platform). See “GoogleGlass on Steroids”.

How many of these “FELL THRU THE CRACK”, and any time between that moment at the airport and 21 days later, developed symptoms-“GOT A COLD” (cold-like symptoms) and started spreading the Ebola-virus. And they might not have been in an area of risk for Ebola, but maybe they just became contaminated by someone else, maybe a few degrees of separation from the actual individual who came from the geographic risk area.

I don’t want to BE ALARMIST but REALISTIC.

We have already seen three INFECTED, SYMPTOMATIC AND INFECTING, patients IN THE USA ( up to the latest report on October 22nd, 2014).

Unfortunately, my prediction is that we are only seeing the “tip of the iceberg” and that in he next several days, we would be finding out many more cases, since it takes at least 21 days for the symptoms to become evident.

I think that this is a problem that requires the most aggressive strategy and that the public needs to be educated (not alarmed BUT AGGRESSIVELY EDUCATED) about the potential of this epidemic to be disastrous, and of the many easy ways to prevent transmission.

ENCOURAGE PEOPLE NOT TO TOUCH ANYONE OR ANYTHING AS MUCH AS POSSIBLE.

ANY SEVERE “COLD” – LIKE SYMPTOMS SHOULD BE TREATED AS EBOLA INFECTION UNTIL PROVEN OTHERWISE, and those patients should be temporarily isolated.

Teach yourself and those around , to be “a little paranoid” about this issue.

Wash your hands and use alcohol-based sanitizer often.

If you come in contact with anyone, WASH YOUR HANDS , USE ALCOHOL BASED SOLUTIONS, DON’T TOUCH YOUR MOUTH, NOSE , EYES OR ANY OPEN SURFACES BEFORE “DISINFECTING” YOURSELF .

I think that this is the type of information that needs to be taught and spread in schools, in public spaces and in the media, as much as possible until this epidemic is under control.

Comments

Rafa, unfortunately we are in danger of a Pandemic d/t the junction of 2 social behaviors: 1. Politicians that don’t lead (because they have no clue); 2. Self Centered People that are used to doing whatever they want, whenever they want.

Nobody likes taking severe measures, however, for the sake of society we need leaders and mature people.

Remember when you and I were younger there was a change of Economic Policy in Venezuela towards free market pricing and there was an Army Rebellion. Initially people were coming out to protest, but shortly after, Marshall Law was declared and hundreds, maybe thousands of looters were killed. Part of the Army and Air Force were against the other Part, I remember seeing hundreds dead as I was a Surgical Intern at Perez Carreño Hospital.

After a few days, they stopped coming out, society stabilized and life went on. There were other victims, innocent bystanders that were watching the looters and the Army killed them.

How do this two stories relate you may ask yourself?

The looters were the people who may have had contact with Ebola. The Army enforcing the Marshall Law is the Ebola Virus. And innocent bystanders are the people in Public Areas such as Airports, Buses, Restaurants, Bowling Alleys that are being exposed to the virus by a group of “SELF CENTERED ARROGANT” people that are being encouraged by the Government to be out and about because “IS ALL UNDER CONTROL”, “THERE’S NOTHING TO WORRY ABOUT”…

The President needs to lead. The Exposed need to stay home, because if not, they will cause a Pandemic. They need to STOP traveling, be responsible and think of others not just themselves…

We are about to enter Flu Season, imagine the panic that will soon come.

The CDC has it on it’s webpage, if you are been exposed and are not sick, stay in West Africa on Quarantine for 21 days before coming back! The second part I don’t agree with, says that if this is not possible, then Charter a Plane back to the US to avoid using Commercial Flights; this is dangerous as well, because we will risk exposing TSA agents, Customs, Immigration, what will happen to the Secretions in the Airplane? Will they be incinerated?

This is the reason why despite having negative testing for Ebola, high risk-individuals should still be very vigilant of their symptoms, so that if they become symptomatic they then avoid ANY risky contact with the public ( self-imposed or forced-quarantine ).http://n.pr/1tdqOej